stances massive rectal injections of tannin 1 oz., gum arabic 1 oz., warm water 1 quart, are of use. If the secretion of urine is not quickly restored, large hot poultices over the loins, dry-cupping of the same region, and the judicious use of bland diluents should be had recourse to. Stimulating diuretics are dangerous. Retention of urine must be inquired about, and the region of the bladder frequently examined, and, if necessary, the catheter employed. In the event of constipation, purgatives must be eschewed and simple enemata alone used.
In cholera convalescents the diet for a time must be of the simplest and most digestible nature— diluted milk, barley-water or rice-water, thin broths, meat juice, and so forth— the return to ordinary food being effected with the greatest circumspection.
Cholera typhoid must be treated much as ordinary enteric fever.
Precautions.— It must never be forgotten by those responsible for the management of cholera cases that through their discharges such patients are a danger to the community, and that those discharges may contain the vibrio in some instances up to fifty days after the attack. The Bordet-Gengou reaction,*[1]a complicated serum reaction, has been advantageously employed in the detection of these cholera carriers. Further, that though the germ dies in a few hours if dried, it preserves its vitality for many days if kept moist, as, for example, in damp, soiled linen; that it may live for months as a saprophyte in water or
- ↑ * The Bordet-Gengou reaction is based on the fixation of the complement, using a culture of the vibrio as an antigen. The following mixtures are prepared in three test tubes: Nos. 1 and 2 contain 0.2 c.c. suspension of cholera vibrio, and 0.6 c.c. suspected person's serum (heated to 56° F. for half an hour), and 0.1 c.c. complement (guineapig's serum); tube 3, a similar mixture with the substitution of normal person's serum. These tubes are shaken and incubated for half an hour. Then 1 c.c. of mixture of a serum hæmolytic to sheep's corpuscles (heated to 56° F. for half an hour) and one volume of washed sheep's corpuscles. To tube 2 is added 0.1 c.c. of a mixture of two volumes of normal saline and one volume of washed sheep's corpuscles. Should the suspected serum be that of a cholera carrier, the complement in tube 1 will be fixed and no hæmolysis occur, whereas in tube 3 it will be free and hæmolysis will take place.
